Lower limb amputation following venous cannulation for VA-ECMO: a case report

Perfusion ◽  
2021 ◽  
pp. 026765912110506
Author(s):  
Natasha Habr ◽  
Jamal J Hoballah ◽  
Jamil Borgi ◽  
Caroline Hamadi ◽  
Pierre Sfeir ◽  
...  
Keyword(s):  
Lower Limb ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Venous Cannulation ◽  
Knee Amputation ◽  
Venous Cannula ◽  
Arterial Insufficiency ◽  
Va Ecmo

Lower limb amputation following arterial cannulation for VA-ECMO has been described in the literature. Limb ischemia however following venous cannulation is very rare and not quite understood. We present a case of limb ischemia following venous cannulation. A combination of venous congestion, compartment syndrome and subsequent arterial insufficiency is the proposed pathophysiology. Shock and use of vasopressors are compounding factors. Limb ischemia can be transient and reversible if diagnosed immediately and treated by early removal of the cannula. Our patient was unstable and ECMO dependent, and removal of the cannula was not an option. This resulted in limb loss and eventual above knee amputation. Use of the smallest appropriate venous cannula and early fasciotomy, in addition to hemodynamic optimization are measures that could help in preventing major amputation.

Rate of and Factors Associated with Ambulation After Unilateral Major Lower-Limb Amputation at an Urban US Tertiary-Care Hospital with a Multidisciplinary Limb Salvage Team

2017 ◽  
Vol 107 (5) ◽  
pp. 355-364 ◽  
Author(s):  
Laura E. Sansosti ◽  
Amanda Crowell ◽  
Eric T. Choi ◽  
Andrew J. Meyr
Keyword(s):  
Lower Limb ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Major Amputation ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Care Hospital ◽  
Factors Associated ◽  
Knee Amputation ◽  
History Of

Background: One relatively universal functional goal after major lower-limb amputation is ambulation in a prosthesis. This retrospective, observational investigation sought to 1) determine what percentage of patients successfully walked in a prosthesis within 1 year after major limb amputation and 2) assess which patient factors might be associated with ambulation at an urban US tertiary-care hospital. Methods: A retrospective medical record review was performed to identify consecutive patients undergoing major lower-limb amputation. Results: The overall rate of ambulation in a prosthesis was 29.94% (50.0% of those with unilateral below-the-knee amputation [BKA] and 20.0% of those with unilateral above-the-knee amputation [AKA]). In 24.81% of patients with unilateral BKA or AKA, a secondary surgical procedure of the amputation site was required. In those with unilateral BKA or AKA, statistically significant factors associated with ambulation included male sex (odds ratio [OR] = 2.50) and at least 6 months of outpatient follow-up (OR = 8.10), survival for at least 1 postoperative year (OR = 8.98), ambulatory preamputation (OR = 14.40), returned home after the amputation (OR = 6.12), and healing of the amputation primarily without a secondary surgical procedure (OR = 3.62). Those who had a history of dementia (OR = 0.00), a history of peripheral arterial disease (OR = 0.35), and a preamputation history of ipsilateral limb revascularization (OR = 0.14) were less likely to walk. We also observed that patients with a history of outpatient evaluation by a podiatric physician before major amputation were 2.63 times as likely to undergo BKA as opposed to AKA and were 2.90 times as likely to walk after these procedures. Conclusions: These results add to the body of knowledge regarding outcomes after major amputation and could be useful in the education and consent of patients faced with major amputation.

scholarly journals Factors that affect the one-year mortality rate after lower limb amputation in the Hong Kong Chinese population

2021 ◽  
Vol 28 ◽  
pp. 221049172110569
Author(s):  
Pui M Chung ◽  
Bolton KH Chau ◽  
Esther C-S Chow ◽  
Kwok H Lam ◽  
Nang MR Wong
Keyword(s):  
Mortality Rate ◽  
Lower Limb ◽  
Chinese Population ◽  
Major Amputation ◽  
Lower Limb Amputation ◽  
Hong Kong Chinese ◽  
Limb Amputation ◽  
The Mean ◽  
One Year ◽  
The One

Introduction Lower limb amputation has significant morbidity and mortality. This study reviews the potential factors affecting the one-year mortality rate after lower limb amputation in the Hong Kong Chinese population. Methods Cases with lower limb amputations (toe, ray, below-knee, and above-knee amputations) from a regional hospital from January 2016 to December 2017 were recruited. Amputations due to trauma were excluded. The one-year mortality rate and the potential risk factors (age, sex, length-of-stay, multiple operations, extent of surgery (minor vs. major), medical comorbidities including (1) end-stage renal failure (ESRF), (2) cardiac diseases, (3) ischemic heart disease, (4) peripheral vascular disease and (5) diabetes mellitus) were analyzed by multiple logistic regression using Matlab 2018a. Results A total of 132 patients were recruited (173 operations). The one-year mortality rate was 36.3%. The mean age at death was 72.2 years. The results of the regression analysis showed patients having ESRF (β = 2.195, t 120 = 3.008, p = 0.003) or a major amputation (including above- or below-knee amputation) (β = 1.079, t 120 = 2.120, p = 0.034), had a significantly higher one-year mortality. The remaining factors showed no significant effect. The one-year mortality rate in ESRF patients was 77.8%; while the one-year mortality rate without ESRF was 29.8%. The mean age at death in the ESRF group was 62.9 years; while that without ESRF was 76.1 years. The one-year mortality for patients with major amputation was 45.8% while that for minor amputation was 20.4%. Conclusion ESRF and major amputation are factors that increase the one-year mortality rate after lower limb amputation.

scholarly journals What happens to our amputees? The Darling Downs experience

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902095847
Author(s):  
Varun Vasudeva ◽  
Adam Parr ◽  
Alan Loch ◽  
Chris Wall
Keyword(s):  
Lower Limb ◽  
Treatment Options ◽  
Major Amputation ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Mortality Data ◽  
Minor Amputation ◽  
Poor Outcomes ◽  
American Society ◽  
End Stage

Background: Major lower limb amputation is occasionally required in the management of end-stage pathology where other treatment options have failed. The primary aim of this study was to determine the 30-day and 1-year mortality rates of patients undergoing nontraumatic major lower limb amputation. Secondary aims were to investigate risk factors for poor outcomes, incidence of previous minor amputation, and the rate of subsequent major amputation. Methods: All nontraumatic, major lower limb amputations performed at Toowoomba Hospital during an 18-year period were retrospectively reviewed. Mortality data were obtained from the Queensland Registry of Births, Deaths and Marriages. Kaplan–Meier analysis was performed to determine survival after amputation. Results: A total of 147 patients were included in the study, with 104 undergoing below knee and 43 undergoing above knee amputations. Ten patients identified as having an Aboriginal and Torres Strait Islander background. For all patients, the 30-day mortality was 4.1% and 1-year mortality was 21.1%. For Indigenous patients, 30-day mortality was 10%. Previous minor amputation had occurred in 40 patients. Twenty-nine patients underwent further minor surgery after their initial major amputation, with thirteen requiring subsequent major amputation. Factors that increased mortality risk were the presence of peripheral vascular disease, an American Society of Anesthesiologists score of four and age greater than 65 years. Conclusion: The morbidity and mortality following major lower limb amputation is significant. The findings of this study highlight the importance of preventative measures to minimize the incidence of lower limb amputations in the future.

scholarly journals Incidence of lower limb amputation in people with and without diabetes: a nationwide 5-year cohort study in Japan

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e048436
Author(s):  
Fumika Kamitani ◽  
Yuichi Nishioka ◽  
Tatsuya Noda ◽  
Tomoya Myojin ◽  
Shinichiro Kubo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Lower Limb ◽  
Time Trend ◽  
Major Amputation ◽  
Significant Decline ◽  
Lower Limb Amputation ◽  
Amputation Rate ◽  
Limb Amputation ◽  
National Healthcare ◽  
Minor Amputation

IntroductionThis study was conducted to investigate the incidence and time trend of lower limb amputation (LLA) among people with and without diabetes.Research design and methodsThis retrospective population-based cohort study was based on the national claims data in Japan, comprising a total population of 150 million. Data of all individuals who had LLA from April 2013 to March 2018 were obtained. We analysed the sex-adjusted and age-adjusted annual LLA rate (every fiscal year) in people with and without diabetes for major and minor amputation. To test for time trend, Poisson regression models were fitted.ResultsIn the 5-year period, 30 187 major and 29 299 minor LLAs were performed in Japan. The sex-adjusted and age-adjusted incidence of major and minor LLAs was 9.5 (people with diabetes, 21.8 vs people without diabetes, 2.3, per 100 000 person-years) and 14.9 (people with diabetes, 28.4 vs people without diabetes, 1.9, per 100 000 person-years) times higher, respectively, in people with diabetes compared with those without. A significant decline in the annual major amputation rate was observed (p<0.05) and the annual minor amputation rate remained stable (p=0.63) when sex, age and people with and without diabetes were included as dependent variables.ConclusionsThis is the first report of the national statistics of LLAs in Japan. The incidence of major and minor LLAs was 10 and 15 times higher, respectively, in people with diabetes compared with those without. A significant decline in the major amputation rate was observed, and the annual minor amputation rate remained stable during the observation period. This information can help to create an effective national healthcare strategy for preventing limb amputations, which affect the quality of life of patients with diabetes and add to the national healthcare expenditure.

scholarly journals Chronic Low Back Pain in Individuals with Lower-limb Amputation

2006 ◽  
Vol 6 (2) ◽  
pp. 67-70 ◽  
Author(s):  
Ademir Kušljugić ◽  
Suada Kapidžić-Duraković ◽  
Zijada Kudumović ◽  
Amela Čičkušić
Keyword(s):  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Lower Limb ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Low Back ◽  
Social Disorder ◽  
War Veterans ◽  
Knee Amputation

Low back pain (LBP) is a common condition in individuals which experienced psychology and physical trauma. LBP is usually found in persons with lower-limb amputation (LLA), as the most common sign of somatisation or inappropriately made prostheses. Our goal was to investigate cases of chronic pain syndrome in persons with LLA and to determine factors, which influence their functional inability due to LBP. Pain after LLA has been studied. 37 persons, including 26 war veterans (70.2 %) and 11 (29.8 %) civilians with LLA due to an illness, were examined. All participants gave their informed consent and filled Oswestry index of disability due to chronic LBP, divided into 10 sections with 6 questions each, with marks in the range 0-5. The average age of 37 analyzed participants with LLA was 46.2+-10.92 years. 30 participants (81.1 %) were married, 4 (10.8 %) were single and 3 (8.1 %) were widows. 27 (73.0 %) participants had below the knee amputation, 5 (13.5 %) had above the knee amputation and 5 (13.5 %) had foot amputation. 33 (89.6 %) participants experienced chronic LBP in the last 2-10 years and 4 (10.8 %) did not have pains. According to Oswestry index for chronic pain higher level of social functionality was found in civilian amputees than in war veterans (p<0.05). Married civilian amputees have higher level of disability during seating (p<0.01), sleeping (p<0.01) and traveling (p<0.05). Higher level of social disorder among civilian amputees is due to the fact that they belong to older group of participants which usually have social integration at the lower degree. More serious problems during seating, traveling and sleeping among this group are probably due to co morbidity. Chronic LBP was found among 89.6 % of the participants. Higher level of social disorder, problems during seating, traveling and sleeping were identified in the civilian amputees and the married participants.

scholarly journals From major amputation to prosthetic outcome: a prospective study of 190 patients in a defined population

2004 ◽  
Vol 28 (1) ◽  
pp. 9-21 ◽  
Author(s):  
A. Johannesson ◽  
G. U. Larsson ◽  
T. Öberg
Keyword(s):  
Health Care ◽  
Prospective Study ◽  
Standard Method ◽  
Lower Limb ◽  
Major Amputation ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Pressure Casting ◽  
Prosthetic Socket ◽  
North East

In this prospective study, the overall treatment and outcome of patients that underwent major lower limb amputation in a defined population is described. The study was performed over a five year period in the Health Care District of North-East Skåne, Sweden. Some 190 patients, permanent inhabitants of the Health Care District, underwent major lower limb amputation. Sixteen (16) of these patients had amputations before the study started and went through late second leg amputation during the period. One hundred and seventy four (174) patients had primary major amputation. Seventy nine (79) were men and 95 were women, with a median age of 81. The re-amputation rate was 17% although the primary knee preservation ratio was as high as 3.0:1. Rigid dressing was the standard method following trans-tibial amputation and was used for 5–7 days. ICEROSS∗ silicone liner was used for compression therapy in 90% of all cases that resulted in delivery of a prosthesis. Prostheses were delivered to 43% of all patients with primary amputations. These patients spent a median of 13 days at the orthopaedic clinic, 55 days at the rehabilitation unit. Pressure casting was used as a standard method in the production of the prosthetic socket. ICEX∗ carbon-fibre socket was used in 52%. New procedures, treatments and techniques were introduced, standardised and evaluated whilst the routines in the hospital were reorganised. In this way, a system has been implemented that better guarantees the outcome of the whole procedure and the service received by this category of patients.

scholarly journals Characteristics of patients who underwent lower limb amputation due to critical limb ischemia – one center experience

2016 ◽  
Vol 30 (3) ◽  
pp. 5
Author(s):  
Andrzej Olech ◽  
Agnieszka Hamera ◽  
Karol Suppan ◽  
Wioletta Banaś ◽  
Liliana Wnęk ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Lower Limb Amputation ◽  
Limb Amputation
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